Cross-Country Differences in Stay-at-Home Behaviors during Peaks in the COVID-19 Pandemic in China and the United States: The Roles of Health Beliefs and Behavioral Intention

The novel coronavirus disease 2019 (COVID-19) rapidly escalated to a global pandemic. To control the rate of transmission, governments advocated that the public practice social distancing, which included staying at home. However, compliance with stay-at-home orders has varied between countries such as China and the United States, and little is known about the mechanisms underlying the national differences. Based on the health belief model, the theory of reasoned action, and the technology acceptance model, health beliefs and behavioral intention are suggested as possible explanations. A total of 498 Chinese and 292 American college students were recruited to complete an online survey. The structural equation modeling results showed that health beliefs (i.e., perceived susceptibility, severity, and barriers) and behavioral intention played multiple mediating roles in the association between nationality and actual stay-at-home behaviors. Notably, the effect via perceived barriers -> behavioral intention was stronger than the effects via perceived susceptibility and severity -> behavioral intention. That is, American participants perceived high levels of susceptibility whereas Chinese participants perceived high levels of severity, especially few barriers, which further led to increased behavioral intention and more frequent stay-at-home behaviors. These findings not only facilitate a comprehensive understanding of cross-country differences in compliance with stay-at-home orders during peaks in the COVID-19 pandemic but also lend support for mitigation of the current global crisis and future disease prevention and health promotion efforts.